Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000500010
Brazilian Journal of Anesthesiology
Clinical Information

Crise tireotóxica associada à doença trofoblástica gestacional

Thyrotoxic crisis associated with gestational trophoblastic disease

Carlos Eduardo David de Almeida; Erick Freitas Curi; Carlos Roberto David de Almeida; Denise Fernandes Vieira

http://dx.doi.org/10.1590/S0034-70942011000500010 Braz J Anesthesiol, vol.61, n5, p.607-609, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A gonadotrofina coriônica humana (HCG) e o hormônio tireotrófico (TSH) apresentam analogia entre suas estruturas, assim como seus receptores. Os altos níveis de HCG encontrados nas doenças trofoblásticas gestacionais podem induzir um quadro de hipertireoidismo secundário. O objetivo deste relato é apresentar um caso em que a administração de contraste iodado precipitou um quadro de crise tireotóxica. RELATO DO CASO: Paciente com mola hidatiforme completa foi admitida no centro cirúrgico com sangramento vaginal intenso após realização de tomografia com contraste iodado. Durante indução anestésica, paciente apresentou quadro compatível com crise tireotóxica. CONCLUSÕES: A incidência de quadros graves associados à doença trofoblástica gestacional tende a diminuir com seu diagnóstico precoce. Ainda que isso aconteça, o anestesiologista deve estar atento à possibilidade de crise tireotóxica nesses pacientes.

Palavras-chave

CIRURGIA, COMPLICAÇÕES, DOENÇAS, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Human chorionic gonadotropin (HCG) and thyrotrophic hormone (TSH) have analogies in their structures, as well as in their receptors. The high levels of HCG seen in gestational trophoblastic diseases may induce secondary hyperthyroidism. The objective of this report was to present a case in which the administration of iodinated contrast triggered a thyrotoxic crisis. CASE REPORT: Patient with complete hydatidiform mole who was admitted to the operating room with severe vaginal bleeding after a tomographic exam with iodinated contrast. During anesthetic induction, the patient presented symptoms compatible with thyrotoxic crisis. CONCLUSIONS: The incidence of severe presentations associated with gestational trophoblastic disease tends to decrease with early diagnosis. Still, the anesthesiologist should be aware of the possibility of those patients developing thyrotoxic crisis.

Keywords

Hydatidiform mole, Intraoperative Complications, Hyperthyroidism, Iodopyridones

References

Yoshima M, Hershmam JM. Thytotropic action of human chorionic gonadotropin. Thyroid. 1995;5:425-434.

Steigrad SJ. Epidemiology of gestacional trofoblastic diseases. Best Pract Res Clin Obstet Gynaecol. 2003;17:837-847.

Sun SY, Amed AM, Bertini AM. Incidência da mola hidatiforme na Escola Paulista de Medicina. Rev Assoc Med. 1992;38:217-220.

Szulman AE. Syndromes of hydatiform moles: Parcial vs. complete. J Reprod Med. 1984;29:788-791.

Soto-Wright V, Bernstein M, Goldstein DP. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775-779.

Lockwood CM, Grenache DG, Gronowski AM. Serum human chorionic gonadotropin concentrations greater than 400.000 IU/L are invariably associated with supressed serum thyrotropin concentrations. Thyroid. 2009;19:863-868.

El-Shirbiny AM, Stavrou SS, Dnistrian A. Jod-Basedow syndrome following oral iodine and radioiodinated-antibody administration. J Nucl Med. 1997;38:1816-1817.

Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005;118:706-714.

Burg H. Iodine excess. Best Pract Res Clin Endocrinol Metab. 2010;24:107-115.

Van der Molen AJ, Thomsen HS, Morcos SK. Effect of iodinated contrast media on thyroid function in adults. Eur Radiol. 2004;14(5):902-907.

Adali E, Yildizhan R, Kolusari A. The use of plasmapheresis for rapid hormonal control in severe hyperthyroidism caused by a partial molar pregnancy. Arch Gynecol Obstet. 2009;279:569-571.

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